Provider Demographics
NPI:1104566272
Name:LIU, LISA GROSSMAN (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:GROSSMAN
Last Name:LIU
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:GROSSMAN LIU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:15 ESCONDIDO VALLE
Mailing Address - Street 2:
Mailing Address - City:MANITOU SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80829-2470
Mailing Address - Country:US
Mailing Address - Phone:719-244-0401
Mailing Address - Fax:
Practice Address - Street 1:1975 4TH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2351
Practice Address - Country:US
Practice Address - Phone:415-476-4562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-29
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA191179208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics